What steps should I take to identify and manage delirium in an older adult presenting to my practice?

To identify delirium in an older adult presenting to your practice: Assess for recent (within hours or days) changes or fluctuations in cognitive function, perception, physical function, or social behaviour, as reported by the person, carer, or relative. Look for signs such as worsened concentration, confusion, hallucinations, reduced mobility, agitation, or withdrawal. Be particularly vigilant for hypoactive delirium signs like withdrawal, slow responses, and reduced appetite. Use the 4AT assessment tool if indicators are present, carried out by a competent healthcare professional. Confirm the diagnosis with a healthcare professional with relevant expertise, and document the diagnosis in the person's record and primary care notes. ¹

To manage delirium: Identify and treat the underlying cause or causes. Ensure effective communication, reorientation, and reassurance, involving family or carers if possible. Address distress with verbal and non-verbal de-escalation techniques; if these are ineffective, consider short-term use of haloperidol at the lowest dose, with caution regarding side effects. Re-evaluate if delirium persists, and assess for possible dementia. Provide information to the patient and carers about delirium, its temporary nature, and support options. Carry out a medication review, address poor nutrition, sensory impairments, sleep hygiene, hydration, infection, immobility, and pain as part of the comprehensive management plan. ¹